Weight-Loss Pills

Evidence Based
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Are weight-loss pills safe?

Weight-loss (diet pills) can be a safe way to assist in a person's weight reduction if prescribed and monitored by a physician and paired with overall diet and lifestyle changes. However, weight-loss pills can be highly addictive due to their stimulant qualities and when misused, even for a brief period of time. There are currently only four weight-loss pills approved by the FDA. Each of these pills has a different effect on the body, which assists in long-term weight loss.

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Losing weight improves health, quality of life, and mobility in patients who are obese and suffering from illnesses and/or side effects related to weight gain. 

Weight-loss pills assist patients in reaching their weight-loss goals and needs by aiding with problems caused by obesity like:

  • Mobility issues and fatigue
  • The inability to exercise due to excess weight
  • Slower metabolism, which is directly related to mobility issues. It is a vicious endless cycle, as increased weight slows down the metabolism 
  • Increased appetite (food addiction), or a dopamine dependency on food

Obesity is a chronic disease. It can take months and years to achieve results. Doctors pair weight-loss pill prescriptions with lifestyle and dietary changes so that patients can achieve  optimum long-term results. 

Weight-loss pills are not replacements for healthy habits. However, the overall effects of these pills on the body are an appropriate tool to assist patients in reaching long term weight-loss goals. 

The side effects and risks of taking weight-loss pills propose a much lower risk than the side effects and health risks of being obese long-term. 

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Common types of weight-loss pills

There are two categories of weight-loss pills, including:

  • Prescription weight-loss pills
  • Over the counter, low dose weight-loss pills
Graphic of four pills to display party drugs.

What drugs are approved in the U.S. for weight loss?

The U.S. Food and Drug Administration (FDA) has only approved the four following prescription weight-loss pills for long-term usage:

  • Contrave, also known generically as naltrexone-bupropion
  • Saxenda or generically as liraglutide
  • Xenical or generically as orlistat
  • Qsymia or generically as phentermine-topiramate

Each weight-loss drug is prescribed and monitored differently over different lengths of time. They are each designed to affect the brain and body in different ways to achieve weight-loss, and therefore each has its own set of side effects. 

Contrave

  • Dosage Type — starting at 8 mg tablet once daily and up to 90 mg daily over twelve weeks.
  • Medication Type — extended-release tablet
  • Generic Name — naltrexone-bupropion
  • Effects — feel fuller faster and makes you feel less hungry.
  • Side Effects — headache, liver damage, vomiting, increased blood pressure and heart rate, or insomnia.

Saxenda

  • Dosage Type — starting dose is 0.6 mg per day for the first week. Doctors will increase the dosage by 0.6 mg each week until a maintenance dose of 3 mg is reached, and the patient maintains dosage for 16 weeks.
  • Medication Type — subcutaneous injection
  • Generic Name — Liraglutide
  • Effects — makes you feel less hungry or full sooner.
  • Side Effects — abdominal pain, headache, and increased pulse.

Xenical 

  • Dosage Type — one 120-mg capsule three times a day with meals.
  • Medication Type — capsule
  • Generic Name — Orlistat
  • Effects — decreases the amount of fat the body absorbs by one-third. Must be paired with a reduced-calorie diet that contains approximately 30 percent of calories from fat.
  • Side Effects — frequent bowel movements or bowel urgency, oily rectal leakage, oily evacuation, and inability flatulate with discharge.

Qsymia

  • Dosage Type — dosage depends on the patient's BMI, body mass index. Patients must take once daily in the morning with or without food. Dosage typically starts at phentermine 3.75 mg/topiramate 23 and can be raised to phentermine 7.5 mg/topiramate 46 mg within 14 days.
  • Medication Type — capsule, extended-release 
  • Generic Name — phentermine-topiramate
  • Effects — Qsymia is a combination of phentermine, a stimulant, and topiramate, a seizure medication paired together to speed up the metabolism .
  • Side Effects — depression, constipation, insomnia, nasopharyngitis, paresthesia, mood disorder, sleep disorder, and raised blood pressure or pulse.

Who is a candidate for weight-loss drugs?

Candidates for weight-loss pills include:

  • Patients who have a BMI over 27 with heart-related health risks like high blood pressure or those who have diabetes.
  • Patients with a BMI over 30 who are considered morbidly obese with one or more co-morbid, or life-threatening diseases and health issues.
  • Patients who struggle with food addiction.

Addiction and Abuse Potential

Weight-loss pills are the most commonly abused prescription drug. These appetite suppressants and metabolism stimulants closely resemble amphetamines. Like many stimulants, the dosage of these drugs must increase over time as the patient will require increasingly higher doses as their system becomes more tolerant to the stimulant. 

When a doctor prescribes a weight-loss pill regimen, they will monitor a patient's tolerance and weight loss results so they can safely increase the dosage as needed. However, it is very common for a patient to misuse a prescription and begin to self-medicate when results decrease and their tolerance rises.

Long-term use and misuse can lead to a substance use disorder (SUD) and drug tolerance. Patients will require a more frequent or higher dosage to achieve the same effects.

Tolerance of weight-loss pills can begin within a few weeks to months. Depending on the patient and their previous habits, a patient could begin misusing the drug as soon as they receive the results from their first check-in appointment due to missed goals.

Many patients who wish to see faster weight-loss results will begin to alter and up their dosage in the hopes of quicker results and will, therefore, need higher doses to achieve the same results in a shorter amount of time. This abuse does not make these drugs more effective. Instead, it opens the patient up to greater dependency and higher health risks.

Graphic of hospital.

Treatment Options for Addiction

Inpatient and outpatient treatment for prescription weight-loss pill addiction is available. The types of treatment vary significantly and can focus on a patient's root issues with weight-loss and body image as well as detoxing the stimulants themselves. A patient can expect to need the support of a long term program in order to break an addiction to stimulants.

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Resources

Andrews, Michelle. "Many Insurers Do Not Cover Drugs Approved To Help People Lose Weight." Kaiser Health News, 28 July, 2016, khn.org/news/many-insurers-do-not-cover-drugs-approved-to-help-people-lose-weight/.

Early, Jessica, and J. Suzin Whitten. "Naltrexone/Bupropion (Contrave) for Weight Loss." American Family Physician, 15 April 2015, www.aafp.org/afp/2015/0415/p554.html.

"Office of Dietary Supplements - Dietary Supplements for Weight Loss." NIH Office of Dietary Supplements, U.S. Department of Health and Human Services, ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/.

"Prescription Medications to Treat Overweight and Obesity." National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, 1 July 2016, www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity.

"Safety Concerns About Prescription Weight Loss Pills." Cardio Smart, www.cardiosmart.org/News-and-Events/2014/02/Safety-Concerns-About-Prescription-Weight-Loss-Pills.

Staff, Familydoctor.org Editorial. "Prescription Weight-Loss Medicines." Familydoctor.org, 12 Jan. 2018, familydoctor.org/prescription-weight-loss-medicines/.

"Top Weight Loss Medications." Obesity Medicine Association, 5 September 2019, obesitymedicine.org/weight-loss-medications/.

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Updated on: September 2, 2020
Author
Michael Bayba
About
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Medically Reviewed
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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